New book says Hemingway suffered an early form of dementia

Today, psychiatrists would believe that trying to diagnose Ernest Hemingway’s mental illness, posthumously, is unrealistic because they never had the chance to speak with him, draw his blood, study an MRI of his brain or interact with his family and friends.

But that didn’t stop renowned forensic psychiatrist Andrew Farah, and he reveals the results his fascinating book “Hemingway’s Brain.”

Hemingway is widely thought to have suffered bipolar disorder and alcoholism that eventually led to his 1961 suicide. But Farah, the chief of psychiatry at the High Point Division of the University of North Carolina Healthcare System, provides a new diagnosis, one that focuses on traumatic head injuries and a detailed neurological and psychological analysis.

Farah’s examination, he believes, sets the record straight with the medical community and Hemingway scholars because Farah believes the tormented author was misdiagnosed — and could have been successfully treated had he not been.

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For starters, Farah astutely tracks Hemingway’s mental illness to his parents Grace Hall Hemingway and Clarence Edmonds Hemingway, the latter of whom committed suicide Dec. 6, 1928. After Clarence perished, at least four more Hemingways killed themselves, including Ernest, his sister Ursula, and his brother Leicester. Ernest’s granddaughter Margaux overdosed in 1996, and his third wife, Martha Gellhorn, took her own life in 1998 in London.

Suicide and dementia are visible themes in Hemingway’s stories, especially in “The Battler,” which features punch drunk ex-fighter Ad Francis, and in “Indian Camp,” wherein the husband of the pregnant Indian woman, in labor, slashes his own throat. Hemingway’s 1933 short story collection, “Winner Take Nothing,” includes the popular “Clean, Well-Lighted Place,” a sparse story set in a Spanish cafe in which two waiters discuss a deaf patron’s suicide attempt by hanging, and in “Fathers and Sons” fact becomes fiction as Nick Adams’ father dies of a self-inflicted gunshot wound. Scholars believe Nick Adams is the autobiographical character of Ernest Hemingway; thus, Nick’s father is Clarence.

Progressive brain injury

But why did Ernest Hemingway commit suicide? I caught up with the author in a phone interview, and according to Farah, “By 1960 Hemingway suffered from a type of dementia, which led to his cognitive decline, a deterioration in his writing skills, and volatility and personality changes. And it was predominantly his nine major concussions that caused a syndrome we now refer to as ‘chronic traumatic encephalopathy,’ or CTE. There were other contributors, such as alcoholism. The CTE meant he would tolerate alcohol less well, and there was also what we now term a ‘vascular’ component to his dementia, that is, an accumulation of tiny strokes over time, as he suffered pre-diabetes and hypertension, probably from his early 40s. But the main cause of his decline was CTE. This was the primary diagnosis; the depression and psychosis were stemming from this syndrome. In a way, he was treated only for symptoms, not his underlying illness.”

Because he was not treated properly, his delusions continued, and readers learn about them in “Hemingway’s Brain.” Specifically, Hemingway believed the FBI was monitoring his actions and that hunting on private land would alert the sheriff. He also had a “persistent fear of arrest for ‘taking liberties with a minor’ ” — spurred by his relationship with 18-year-old Adriana Ivancich of Italy. (Hemingway was 49 when he met Ivancich, who inspired the character Renata in “Across the River and into the Trees.” Ivancich committed suicide in 1983.)

In addition to the passages about the delusions, Farah provides detailed accounts of the litany of concussions Hemingway suffered, including one he experienced when a mortar shell exploded near him in Italy during WWI, a famous story about a skylight falling on his head in Paris in 1928 and a brain rattle suffered in a car crash during WWII in London with new acquaintance Dr. Gorer at the wheel. Add two more resulting from back-to-back African plane crashes on two days in 1954 and the after-effects from hundreds of rounds of boxing, and Farah had a lot to work with.

History of suicide attempts

Although Hemingway’s suicide in Ketchum, Idaho, made worldwide headlines on July 2, 1961, Farah points out several other occasions that Hemingway pondered taking his life. In fact, when he first married Hadley Richardson, he cogitated jumping into the Atlantic Ocean on his way to Paris, and he contemplated walking into a plane’s propeller on his way to the Mayo Clinic in the final years of his life. (Hemingway’s doctor Georg Saviers, however, disputes this action; the propeller story has been written about ad nauseam, but in Farah’s book, Saviers “had no sense that Papa was ready to run into either of the rotating blades.”)And two months prior to his death, his wife, Mary, found him holding a shotgun, shells and a suicide note.

Doctors tried several times to level Hemingway’s mood with invasive shock treatments and in-patient stays at the Mayo Clinic in Minnesota, and Farah places the reader bedside for one of Hemingway’s shock treatments. “An intravenous line was started in his arm, and amobarbital flowed into his veins … the rubber bite-guard was placed in his mouth, and a conductive gel was rubbed in the circles over his temples.” When he woke up, his head “felt cloudy” and he did not like this feeling: “Well, what is the sense of ruining my head and erasing my memory, which is my capital” — which may have been the impetus for his obsession with ending his life. Farah, via phone, laid out his multipronged treatment plan (also featured in his book), which may have helped Hemingway:

“Firstly, we’d have to address the alcoholism. He described a life without alcohol as driving a race car without motor oil, and though he could cut down on drinking, he was never fully abstinent. For such patients, we may prescribe a medication like diazepam, which prevents withdrawal and may provide the same anti-anxiety relief as alcohol. It is also addicting but spares the liver and brain damage of the alcohol. Then I would design a realistic exercise program, which would include increasing his walking and swimming, and prescribe a particular B vitamin capsule (Enlyte-D) that would lower the toxins in his brain. Antioxidants such as NAC (or n-acetylcysteine) are used in high doses by the military to protect the brain after blast-injury concussions. It also helps to reduce the cognitive decline in dementia. We would also use an omega-3 supplement, which would assist in restoring the integrity of his brain cells. We would add the standard anti-Alzheimer’s medications (memantine and rivastigmine), and finally, an antipsychotic and an antidepressant would address his delusions and depression.”

Too bad Hemingway was not treated today because the passage about Hemingway’s final morning is harrowing.

“That morning, July 2, 1961, Ernest woke just before sunrise and put on his slippers, then his red bathrobe dubbed the ‘Emperor’s Robe.’ ... He then went directly to the windowsill in the kitchen, where he knew he would find the keys he needed. He then made his way to a storeroom in the basement where his guns were locked up.” Readers know what happened next.

Just like the husband in “Indian Camp,” the cafe patron in “A Clean, Well-Lighted Place” and Mr. Adams in “Fathers and Sons,” Hemingway’s suicide will never be fully understood and doctors will never know if they could have saved him, but Farah’s thought-provoking and cogent examination provides the unique perspective of a respected psychiatrist that will aid Hemingway aficionados and literary scholars in discerning just a little bit more about the tormented mind of a man who is admired worldwide.

Wayne Catan teaches English literature at Brophy College Preparatory in Phoenix.